DESCRIPTION: (Applicant's Description) Breast cancer is the second leading cause of death from cancer among women overall, and African-American women consistently have lower survival and cure rates than white women. Although mortality could be substantially reduced with early detection, adherence to screening recommendations is particularly poor among older, low income African-American women and among rural women. This argues compellingly for research to enhance adherence to screening recommendations in this population. The overall objective of this proposed three-year project is to build on established NCI-funded projects to develop and evaluate practice-based, patient-outreach procedures to increase adherence to mammography screening recommendations among low-income, minority women in rural Alabama. Interventions based on Social Cognitive Theory and the Transtheoretical Model will be designed to promote accurate cancer risk appraisal and influence cancer-related attitudes, thereby increasing adherence to mammography recommendations. A nested design will be used to evaluate a stepped-care implementation of practiced-based patient-outreach procedures on adherence to mammography screening recommendations. Three hundred and twenty women aged 50 and older who have not had a mammogram in the previous 12 months will be identified among rural, low-income, African-American patients receiving care from West Alabama Health Services. Participants will be randomized to one of the two Step 1 treatment conditions: General Screening Notification Letter or No Letter control. Women in either of the Step 1 conditions who have not received screening mammography at the end of the six-month Step 1 follow-up will then be randomized to one of two Step 2 treatment conditions (Tailored Risk Notification Letter or Tailored Risk Appraisal Interview) and will be followed for a six month Step 2 follow-up. Primary outcome measures for Step 1 and Step 2 interventions will be the proportion of women who receive a mammogram within the respective six-month follow-up periods. Secondary measures will be collected to examine how perceptions about cancer risk, attitude about cancer control practices, stage of readiness for mammography, and social support are associated with treatment outcome. The applicant also proposes to monitor intervention costs to conduct economic analyses of interest to organizations which might implement of the proposed interventions should they prove effective.